Provider Demographics
NPI:1952746075
Name:JURGENSEN, SHERLYN G (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHERLYN
Middle Name:G
Last Name:JURGENSEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHERLYN
Other - Middle Name:G
Other - Last Name:JURGENSEN-BOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 S WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:MO
Mailing Address - Zip Code:64473
Mailing Address - Country:US
Mailing Address - Phone:660-446-2090
Mailing Address - Fax:660-446-2089
Practice Address - Street 1:109 N BLUE JAY DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1906
Practice Address - Country:US
Practice Address - Phone:816-691-1424
Practice Address - Fax:816-480-4511
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013002953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952746075Medicaid
MOMO4000008Medicare UPIN